Rosenblum: Minnesota dental therapy model goes nationwide

Christy Fogarty was certified Feb. 15 as the state’s first advanced dental therapist, which is reason to cheer unless you’re 7-year-old Tia Seaberry.

Tia, wearing pink sequined boots and bluejeans on a recent Wednesday morning, will be forgiven for dampened enthusiasm as Fogarty prepared to extract an infected baby tooth at Children’s Dental Services in Minneapolis. The procedure wouldn’t have been any more welcome had Justin Bieber been doing it.

“Are you nervous?” Fogarty asked, rubbing numbing jelly on Tia’s gums. “It’s normal. I’m going to tell you everything. I’m going to put a little bit of sleepy juice up there. Is it making your tongue feel funny? Good. We like it to do that.”

Fogarty’s professionalism and soothing presence are coming in handy on another front. In February, she testified in front of the New Hampshire Senate Health, Education and Human Services Committee. New Hampshire, as well as nearby Maine and Vermont, are among nearly two dozen states looking to Minnesota for guidance in creating their own brand of dental therapists.

These midlevel professionals span the divide between the hygienist and the dentist, much like a nurse practitioner or physician assistant, both of whom met equally vocal pushback from the medical establishment.

“Minnesota is definitely a pioneer and constantly referenced in other states,” said Julie Stitzel, campaign manager for the Pew Children’s Dental Campaign, whose mission is to increase dental access to low-income children.

“We can actually use data from Minnesota,” she said, “instead of theoretical models suggesting what we think will happen. Now we can say, ‘This is what we know will happen.’ ”

What we know is that dental therapists fill huge holes in basic dental care for low-income patients. It’s shameful, frankly, that Minnesota has a children’s tooth-decay rate higher than the national average (among third-graders it’s 55 percent, compared with 53 percent). It’s shameful, too, that Minnesota reimburses dentists at among the lowest rates in the nation.

It’s no surprise, then, that about 24 percent of dentists in a recent survey said they’ve stopped taking Medical Assistance patients.

Still, dental therapists and their many allies faced a formidable battle against the Minnesota and American Dental associations.

So Fogarty, 42, was well-prepared for the questions that arose in New Hampshire.

“I spoke to how it’s working here,” Fogarty said. She emphasized that she’s not taking any jobs away. “My scope of practice is so narrow,” she told them. “I focus on getting people out of pain.”

In Maine, the Act to Improve Access to Oral Health Care Bill also was influenced by the Minnesota model, said Ned McCann, executive director of the Maine Children’s Alliance.

Maine’s “dental hygiene therapists” will be required to do 500 hours under the direct supervision of a dentist, leading to indirect supervision after that. McCann is “cautiously optimistic” that the bill, to be heard April 11, will pass.

Dr. Leon Assael, dean of the University of Minnesota School of Dentistry, wrote a letter of support to New Hampshire and provided testimony for Maine in support of what he calls “this great advance in dental care.”

Similar bills are being considered in California, Kansas, New Mexico and Ohio, among other states.

Dental therapists work under a dentist’s supervision and are trained to do such things as fill cavities, place crowns, give local anesthesia and, in some cases, pull teeth.

After logging the required 2,000 hours of clinical experience, Fogarty’s advanced status allows her to work without on-site supervision, giving her flexibility to practice in such places as nursing homes, Head Start clinics, homeless shelters or emergency rooms. She also can do more complex procedures, such as removing adult teeth. But her heart belongs with children.

“These are binocular glasses,” she tells Tia. “They make your teeth look huge.” She gently squeezes Tia’s finger to show her the kind of pressure she’ll feel when her tooth is coming out.

Fogarty, a graduate of Metropolitan State University, practices at least once a week at the “crazy busy” Children’s Dental Services headquarters, seeing as many as 15 kids daily and pregnant women, too.

“Part of what got me interested in dental therapy,” said Fogarty, “was access problems everywhere. Dentists ask, ‘Now, explain to me again what you do?’ When they understand, they say, ‘Oh, that’s not such a big deal.’